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Why are coronavirus deaths doubling in Florida’s nursing homes?

Advocates blame the lack of a state strategy for accurate and immediate testing at facilities.
Aerial image of the Seminole Pavillion Rehabilitation and Nursing Services building at Freedom Square on Dec. 2 in Seminole. One of the largest death tolls at long-term care facilities in the state is at Freedom Square.
Aerial image of the Seminole Pavillion Rehabilitation and Nursing Services building at Freedom Square on Dec. 2 in Seminole. One of the largest death tolls at long-term care facilities in the state is at Freedom Square. [ LUIS SANTANA | Times ]
Published Dec. 23, 2020
Updated Dec. 23, 2020

TALLAHASSEE — An alarming surge in coronavirus infections and deaths in Florida nursing homes since October has elder care advocates warning that the lack of a state strategy for accurate and immediate testing at elder care homes will mean this holiday season will be a heartbreaking one for many.

On Tuesday, AARP released a report that shows that the COVID-19 death rate among Florida nursing home residents doubled in the three weeks around the Thanksgiving holiday, and infections continue to climb among the state’s most vulnerable residents. The death toll spike was so alarming that AARP decided to report on the data rather than wait for its scheduled monthly release on Jan. 10.

“The fundamental problem is the continued inability to provide accurate, rapid-result testing of everyone entering elder-care facilities — staff, visitors, family caregivers and vendors,’' said David Bruns, spokesman for AARP.

“Absent any change in policy, this surge is going to increase. People are going to die,’' warned Brian Lee, director of Families for Better Care, a nonprofit that advocates for families of nursing home residents. “It’s a total disaster because the governor and his team could have saved lives.”

Also on Tuesday, Gov. Ron DeSantis held a news conference at The Villages retirement community to announce that Floridians over 70 will be next in line to get vaccinated for COVID-19, before essential workers and younger people with underlying health conditions. On Wednesday, he signed an executive order prioritizing vaccines for people over 65, a demonstration he was advocating for one in five Floridians in the ongoing debate among public health experts about who should be first in line with the vaccine.

“If you’re in the elderly population, this is coming soon, and just stay tuned,” DeSantis said Tuesday. “We’re a lot further along than we thought we’d be four months ago.”

Related: How did the coronavirus overwhelm a Seminole nursing home so quickly?

For elder-care advocates, however, the focus on the vaccine is a positive development but it should not shift focus from the deadly numbers emerging at long-term care facilities.

“Gov. DeSantis is ignoring the infection surge by shifting the narrative to vaccine deployment,’' Lee said.

As of the state’s Dec. 21 report, COVID-19 has killed 7,938 Florida residents and staff at elder-care facilities with resident infections outpacing staff for the first time since the summer surge.

“This is hardly unique to Florida,” said Bruns of AARP. “Nine months into the pandemic emergency, we still cannot reliably identify who might be bringing the virus into these facilities and stop them at the door. This means the virus can continue to exploit longstanding weaknesses in infection control that have bedeviled the long-term care industry for decades.”

Optional testing isn’t working

As elders leave their homes to visit loved ones, or welcome visitors over the holidays, the state has no requirement that anyone be tested to prevent the spread of the infection. It allows each facility to establish its own rules.

“Optional testing was a serious flaw,’' Lee said. When the state reopened visitation policies in October, Surgeon General Scott Rivkees suggested that testing be required but didn’t demand it, he said.

The result, he said, is that testing is optional and “facilities are still in the dark.”

“Those folks leaving to see family for the holiday are not tested upon their return,’' Lee said. “People don’t know if you have been in contact with someone who isn’t showing symptoms of the virus and can carry it back to the facility.”

For months, Lee has been advocating for molecular point-of-care rapid tests of visitors on site, as well as residents returning to facilities.

“A better policy would be to shore up testing with the right equipment and test along with the vaccine,’' Lee said. “Families who want to visit their loved ones won’t be inoculated for months. There will be residents and staff who will refuse vaccination. That’s why facilities still need robust molecular testing at the door.”

DeSantis and state health officials have said since March that their priority is to “protect the vulnerable” and they have said they have put a priority on directing testing resources and personal protective equipment to long-term care facilities.

But since January, according to industry data reported to the federal government, more than 93 percent of Florida elder-care facilities have had at least one coronavirus case and, in December, one in seven Florida nursing homes reported that they had less than a week’s worth of personal protective gear on hand for staff, residents and visitors.

ALFs must wait for vaccine

Questions are also emerging about how long elders will have to wait for the vaccine. As the governor watched members of The Villages retirement community get vaccinated Tuesday, assisted-living facilities administrators were told they would have to wait until their residents could get in line.

An email Wednesday from a sales director at Omnicare, the CVS company administering the vaccine at nursing homes and assisted living facilities in Florida, told an official that the company was “not scheduling ALF communities in Florida” for vaccine distribution but were instead “waiting on the Governors office to activate ALF communities.”

Bruns, the AARP spokesman, said “Florida is doing significantly better than most states’' in its handling of the pandemic. “But given the catastrophic failure of the federal and state governments and the industry to protect these vulnerable people, and with nearly 8,000 dead from infections that began in Florida elder-care facilities, there is nothing here to celebrate. No state is protecting frail elders well.

“We need a new vision for long-term care in the Sunshine State.”

Meanwhile, AARP, which has also emerged as a critic of the way the state manages its elder-care industry and those living with a disability, is joining with other advocates like Families for Better Care to call for a fundamental change in Florida’s approach to nursing homes and long-term care.

Lost confidence

“Consumer confidence in the system of large, residential long-term care facilities has collapsed,’' AARP says on its website. “Families are balking at placing their loved ones in facilities that have become Petri dishes for contagion, sending occupancy rates in nursing homes and assisted living facilities sharply down.”

Among the practices that have allowed COVID-19 and other infections like the flu, MRSA, staph and strep infections to fester in most nursing homes and many assisted-living facilities revolve around meals and socializing. Residents are brought from their rooms to congregate for meals and activities.

AARP calls for decentralizing residents and staff into smaller groups to limit exposure to infection and promote residents’ health.

“In many ways, the pandemic has forced us to confront challenges in caring for older Floridians,” said Jeff Johnson, AARP Florida’s state director. “It is clearly time for a better, more effective system that helps millions of older Floridians live as long as possible in their homes and communities, and then receive the care they deserve if residential facilities are the appropriate setting.”

The organization is calling for an end to what it calls a bias in the Florida state budget that puts a priority on funding for nursing home care and placing elders in institutional residential care facilities “instead of empowering and supporting 2.9 million family caregivers to provide care for elders at home and in their communities.”

Johnson said that about 79 percent of the financing for nursing homes in Florida is public funding through Medicaid and Medicare programs and “yet for years, state and federal governments have allowed longstanding problems to fester.”

Although Florida legislators have remained on the sidelines as DeSantis has controlled the messaging and response to the pandemic, lawmakers have said they are considering giving immunity from civil lawsuits to companies operating long-term care facilities.

Johnson said AARP Florida strongly opposes any such proposal.

“Florida law already makes it difficult for families to hold nursing-home operators accountable in court for negligent acts or omissions affecting their residents,’' he said. “Immunity would give these companies impunity to shirk responsibility for providing the care that taxpayers and families have paid for.”

Times staff writer Lawrence Mower contributed to this report.

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